Başak ALTIPARMAK, Ali İhsan UYSAL, Melike KORKMAZ TOKER, Semra GÜMÜŞ DEMİRBİLEK

Ciddi ankilozan spondilitte açık ventral herni tamirinin anestezisi için erektör spina alan bloğu

Ankilozan spondilit, havayolu ve aksiyel iskelet tutulumu nedeniyle anestezistler açısından zorlu bir hastalıktır. Ciddi ankilozan spondilit yakınması olan 55 yaşındaki bir erkek hasta Anesteziyoloji kliniğine başvurdu. Orta hat açık ventral herni onarımı planlanmıştı. Ameliyatın tam anestezisi için 4 mcg kg-1 saat-1 dexmedetomidine sedasyonu ile birlikte T8 seviyesinden bilateral ultrason rehberlikli erektor spina alan (ESP) bloğu yapmaya karar verdik. ESP bloğunu 25 mL %0,25 bupivakain ile yaptık ve aynı işlemi karşı tarafta tekrar ettik. Yirmi beş dakika sonra cilt insizyonu başladı. Operasyon boyunca ek bir anestezik veya analjezik ajan uygulamaya gerek duymadık. ESP bloğu, enjeksiyon seviyesine göre spinal sinirlerde ventral rami ve komünikan ramiyi etkileyerek, farklı dermatomlarda analjezi sağlar. T7-T9 seviyeleri arasından uygulandığında, farklı tipte ameliyatlardan sonra etkili şekilde postoperatif ağrıyı azalttığı bildirilmiştir.

Erector spinae plane block for anesthesia of open ventral hernia repair in severe ankylosing spondylitis

Ankylosing spondylitis (AS) is a challenging disease for anesthesiologist due its airway and axial skeleton involvement. A55-year-old male patient suffering from severe AS, admitted to anesthesiology clinic. He was planned to receive a midlineopen ventral hernia repair. We decided to perform bilateral ultrasound-guided erector spinae plane (ESP) block at the level ofT8 with 0.4 mcg kg-1 hour-1 dexmedetomidine sedation for complete anesthesia of the surgery. We performed ESP block with25 mL of 0.25% bupivacaine and repeated the same procedure at the contralateral side. Twenty minutes later, the skin incisionwas started. We did not need to apply an additive anesthetic or analgesic drug throughout the surgery. ESP block providesanalgesia for different dermatomes by effecting ventral rami and rami communicantes of spinal nerves depending on the levelof injection site. When performed between T7 and T9 levels, it has been reported to effectively attenuate post-operative painafter different types of surgeries.

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